A spark of change: developing an innovative gerontological nursing intervention mapping initiative for training and education (IGNITE)

Background With an aging global population and advancements in medical technology, there is an urgent need for innovative gerontological nursing education programs. This study aimed to develop and evaluate the Innovative Gerontological Nursing Intervention Mapping Initiative for Training and Education (IGNITE) program. This program is a digital platform-based postgraduate nursing curriculum that employs the Intervention Mapping Approach (IMA) and Transformative Learning Theory to address the evolving needs of gerontological nursing. Methods The IGNITE program’s development process encompassed a comprehensive approach, including needs assessment, mapping of course objectives, integration of theory-based methods and strategies, course design, implementation, and rigorous evaluation. The pilot evaluation study involved pre- and post-tests focused on ageism, attitudes towards elder care, knowledge about older adults, transformative behavior change, and program satisfaction. The findings revealed significant improvements across all these dimensions, affirming the effectiveness of the program. Results The program leveraged experiential learning, critical reflection, and rational discourse to facilitate transformative educational experiences. Notably, pre- and post-test comparisons showed marked improvements in attitudes towards older adult care and dementia care knowledge. Participants expressed high satisfaction with the program, with significant reported changes in transformative behaviors. The study also illuminated the initial negative attitudes of clinical nurses towards older adults and underscored the importance of transformative learning experiences in fostering empathy and understanding. Conclusions The IGNITE program lays a foundational framework for developing educational materials that promote transformative learning and self-reflection among healthcare professionals. This approach can lead to innovative nursing practices and personal growth. The application of the IMA and Transformative Learning Theory in gerontological nursing education shows significant promise. Future research should focus on exploring the long-term impacts of such programs and their applicability in diverse healthcare settings.

A spark of change: developing an innovative gerontological nursing intervention mapping initiative for training and education (IGNITE) HeeKyung Chang 1 and Young Joo Do 2* Background As Korea rapidly approaches the threshold of a superaging society, with projections indicating that 20.6% of its population will be older adults by 2025 [1], there is an emerging critical need for an adaptive healthcare service and delivery system.This evolution is tailored to the changing demographic landscape, aiming to effectively manage chronic diseases and incorporate advanced medical technologies [2].In response, the Korean government has strategized to enhance wellness, well-dying, and well-aging [3].This paradigm shift accentuates the importance of gerontological nursing education, particularly focusing on the emotional and creative dimensions of older adult care, incorporating empathy and the application of smart healthcare technologies, such as digital platforms and assistive devices.
The Intervention Mapping Approach (IMA), traditionally employed in health promotion, has been adapted for the development of training and educational programs for practicing nurses [4][5][6][7][8][9].IMA is a systematic process that includes a thorough needs assessment, setting objectives, selecting theory-based methods, and program implementation and evaluation.Despite IMA's proven effectiveness in program development, there is a notable gap in research on post-development program evaluation, particularly in Korea and other regions employing IMA [10,11].This gap is significant, considering the need for comprehensive assessments of the effectiveness of IMA programs, especially since most existing studies have focused primarily on development stages or protocol outlines.Previous research has shown IMA's potential to effectuate changes in cognitive, attitudinal, belief, and self-efficacy aspects among practicing nurses [12,13].
In the current healthcare paradigm, which is shifting towards precision and predictive medicine, gerontological care is increasingly focusing on personalized, patientcentered management.This is crucial considering the prevalence of multiple chronic diseases among older adults and their diverse physical, functional, and cognitive needs [14].Standardized nursing protocols may be insufficient for such varied requirements.Therefore, specialized gerontological nursing education, aligned with the advancements of the Fourth Industrial Revolution and tailored to the specific needs of older adults, is essential for nurses to effectively engage in gerontological care.The Fourth Industrial Revolution, synonymous with state-of-the-art status, digitization, and smart automation, denotes a paradigm shift in technological advancement.It encompasses the phenomena of hyperconnectivity, super-intelligence, and mega-convergence among people, objects, and spaces, leading to the innovation of industrial structures and the overall societal system.This revolution is underpinned by the technologies of the Internet of Things (IoT), Cyber Physical Systems (CPS), and Artificial Intelligence (AI), including automation, data exchange, and manufacturing technologies.In healthcare, the integration of biotechnology and information and communication technology has enabled the early prediction and management of diseases.Furthermore, the development of personalized medication based on an individual's genetic characteristics has become feasible, emphasizing the values of 'prediction, ' 'customization, ' and 'personalization.' [15].
To transform the approach of experienced nurses in clinical settings and encourage a shift from conventional practices, this study introduces the application of transformative learning theory, fostering a change in cognitive structures through the creation of new meanings.Transformative learning fosters a change in cognitive structures through the creation of new meanings, involving experience, critical reflection, rational discourse, and action [16][17][18].Reflective writing, a key element of this theory, facilitates self-communication and empathy, enhancing communication skills, critical thinking, positive coping mechanisms, and empowerment [19,20].Building on this, we developed the Innovative Gerontological Nursing Intervention Mapping Initiative for Training and Education (IGNITE) program, a groundbreaking educational program in gerontological care for experienced nurses, utilizing the Intervention Mapping process.
The specific objectives of this study are as follows:

Design and setting
The IGNITE program employs an educational instructional systems design model, specifically the Intervention Mapping Approach (IMA) [21].IMA is a systematic process used to develop tailored health interventions, involving a comprehensive assessment of needs, setting measurable objectives, creating strategies, and evaluating outcomes.This program targets professional gerontological nurses in hospitals and clinical nursing graduate students, with a focus on enhancing care for older persons with chronic illness, aligning with the advancements in medical technology and healthcare delivery.

Methods
The study utilized the Intervention Mapping Protocol as outlined by Bartholomew et al. [21,22], encompassing six phases (Fig. 1).

Needs assessment
This initial phase involved conducting interviews, on-site investigations, and assessments with the target group and relevant stakeholders.A thorough literature review and information gathering were essential to understand the target group's characteristics, available resources, and potential obstacles for program development.All interview and survey procedures were approved by the Institutional Review Board (IRB) of Gyeongsang National University.Participants provided informed consent, ensuring voluntary participation and confidentiality.

Survey and interviews
Conducted at the Gerontological Health Research Center of Gyeongsang National University, these activities gathered insights into the current state and needs of innovative gerontological nursing education.Focus group interviews involved both practicing hospital nurses and nursing students, ensuring a comprehensive needs assessment.These surveys and interviews were integral to the needs assessment phase and formally conducted as part of the research process.The results directly informed the development of the IGNITE program.

Mapping of course objectives
The goal was to train nurses in innovative gerontological nursing suitable for the fourth industrial revolution era.This phase used Mezirow's transformative learning theory [23,24] and a comprehensive literature review, including references to theoretical determinants, to structure the educational program.

Theory-based methods and strategies
The program leveraged transformative learning, engaging students through critical reflection and discourse, shifting from transmissive to transformative learning paradigms.

Course design
Integrating information from earlier phases, the course was developed with detailed materials and validated for the target population, incorporating aspects of medical technology in gerontological care.

Implementation and evaluation
Detailed plans were formulated for program execution, participant engagement, and mediation framework, with the program's effectiveness evaluated through scientific methods.

Pilot program intervention
This pilot intervention followed a single-group pretestposttest design.

Participants
Enrolled were 30 individuals from Gyeongsangnam-do, Korea, including both registered hospital nurses and clinical nursing graduate students.Criteria for participation included an understanding of the study's purpose, willingness to participate, possession of a nursing license, and at least one year of clinical experience.

Research measurements
In the pilot program intervention, comprehensive measurements were conducted using validated tools to assess participants' perspectives and knowledge on gerontological nursing: Ageism and attitudes: We employed the Fraboni Scale of Ageism (FSA) [25] and Kogan's Attitudes towards Older People (KAOP) scale [26] to assess ageism and attitudes towards older adults.Both scales have been validated in Korean versions [27,28] with satisfactory Cronbach's alpha values.

Knowledge assessment:
The Fact on Aging Quiz Part 1 (FAQ 1) by Palmore [29], translated and validated for a Korean context [30], was used to gauge participants' knowledge about various aging-related aspects.

Behavioral change and satisfaction:
To evaluate transformative behavioral changes, a modified Learning Activity Survey [31,32] was administered, focusing on changes experienced during the learning process.Additionally, program satisfaction was measured using a tailored 5-point Likert scale survey, assessing overall satisfaction, understanding, and usefulness.

Education and data analysis
The intensive 8-hour educational program spanned two days, with evaluations conducted using IBM SPSS Statistics 23.0 for pre-and post-program assessments.

Phase one -needs assessment
The comprehensive needs assessment involved analyzing the current status and requirements for gerontological nursing education.The assessment included a review of existing literature and consultation with experts in the field to establish a foundational understanding for the program's development.Through an extensive review of the literature, we pinpointed the prevailing issues faced in providing geriatric nursing education to postgraduate nurses.This examination was crucial for understanding the gaps and areas needing enhancement within the current educational framework.Before moving on to the second phase of our study, which encompassed conducting comprehensive surveys and in-depth interviews, we meticulously crafted and selected specific questions to be included in the survey questionnaire.Additionally, we meticulously formulated questions for the Focus Group Interviews (FGI) to ensure a rich, detailed exploration of the experiences and needs of postgraduate nurses in geriatric care.This preparatory step was fundamental in aligning our data collection instruments with the identified educational challenges and objectives, thereby facilitating a targeted and insightful assessment of the educational needs and preferences of postgraduate nurses in the field of geriatric nursing.

Phase two -survey and interview
A detailed survey conducted among 154 clinical nurses from 2nd and 3rd tier hospitals in the Gyeongsangnamdo region revealed key demographic and professional data (Table 1

Phase three -mapping of course objectives
Based on the needs assessment and survey findings, the course objectives were formulated to enable nursing professionals to provide high-quality gerontological care in a rapidly evolving medical environment.Specific objectives targeted improvements in knowledge about older adults and dysphagia, attitudes towards ageism and older adults, and the development of transformative behavior (Table 2).

Phase four -theory-based methods and strategies
The program's theoretical approach incorporated experiential learning, critical reflection, and rational discourse.Participants experienced the physical challenges of aging through simulation suits and engaged in reflective journal writing to critically assess their perceptions and biases.

Phase five -course design
The IGNITE program consisted of six targeted modules, each addressing specific learning objectives such as nursing care for geriatric patients with arthritis, prevention of cognitive impairment, and end-of-life care.Innovative educational techniques like simulation and experiential learning were employed to deepen understanding and empathy for older adults.Learning objectives, modules, and teaching methods for the program are presented in Table 3.

Phase six -implementation and evaluation
The

Learning Objectives Aligned Modules
Teaching Methods • Learners will be able to describe the normal physiological changes associated with aging and their impact on functional abilities.• Learners will identify common health conditions related to aging and their effects on functional abilities.• Learners will apply person-centered care principles in the nursing care of older adults • Learners will conduct a comprehensive nursing assessment for older patients with arthritis, including evaluating pain and functional status.• Learners will create a nursing care plan tailored to the specific needs of older patients with arthritis, focusing on pain management, exercise programs, and pharmacological treatments.assessment of its impact.The participants, averaging 34 years in age, mostly had no religious affiliation (73%) and had diverse experiences living with older adults.Key improvements were observed post-program, including a significant decrease in ageism (t = 2.36, p =.025) and improved attitudes toward older adult care (t=-4.18,p <.001).Additionally, knowledge about dementia and attitudes toward dementia care showed substantial increases.These results are detailed in Table 4.
A major aim of the IGNITE program was to promote transformative behavior.After completing the program, participants reported changes in various aspects of their behavior, with an average transformative behavior score of 7.9 out of 10.This score indicates substantial changes across multiple behavioral aspects.
High levels of participant satisfaction were recorded, with average scores of 4.9 for both program satisfaction and understanding, and 4.8 for usefulness.These satisfaction metrics, along with the detailed process of the program's development, are presented in Table 5.The research director regularly supervised the interventionists to ensure the quality of the program and addressed operational challenges and sustainable solutions.

Discussion
This study, leveraging the Intervention Mapping Approach (IMA), makes a significant contribution to the field of gerontological nursing education.Notably, it comprehensively encompasses program development, implementation, and evaluation, which marks a departure from the traditional scope of nursing education programs in Korea.
Our study aligns with the emerging trends in nursing education, as highlighted by recent literature.Choi, Lee and Vorderstrasse [33] underscore the necessity for nursing programs to evolve with the changing healthcare landscape, especially with the integration of technological advancements.Our approach, which includes the use of care-assistive robots and simulations, mirrors these recommendations.
The study discusses three important implications.Firstly, it interprets the experiential-critical reflectionrational discourse-action stages as an educational experience in which clinically experienced professional nurses interpret the stages of progressive change.This approach is in line with previous research, which highlights the importance of considering learners holistically and contextually [34].Transformational learning is a process that creates better beliefs and expectations by changing the referential structure that influences the formation of perception, cognition, and emotion of adult learners, and aims for positive behavior change [35].In this study, it was confirmed that participants created a new referential structure for resolving cognitive errors they had through writing and sharing their experiences in reflective journals, open discussion, experiential learning, and presentations.
The emphasis on transformative learning in our study finds resonance in the work of Rojo et al. [36], who explored how experiential learning and critical reflection contribute to reshaping the perceptions and practices of nursing professionals.Our findings extend this discussion by demonstrating how nurses can develop new cognitive frameworks that are more inclusive and empathetic towards the needs of older adults, in line with the theoretical determinants identified in our study.
The integration of technology in our educational strategy, particularly the use of medical technology such as care-assistive robots and simulations, is in line with Soriano et al. [37].This reflects the increasing relevance of technological tools in not only nursing education but also in other health professions like medicine.Their research emphasizes the impact of technology on enhancing the quality and effectiveness of care, especially in gerontological settings.
Our study's use of the IMA and its focus on mediation within the educational process have broader implications beyond nursing, extending to other health professions.This interdisciplinary approach underscores the importance of integrating various aspects of gerontological care into the curriculum.
The observed behavioral changes in our study participants align with the principles of transition theory, as discussed in Bakon et al. [38].Their research indicates that educational interventions are pivotal in initiating changes in nursing practices and attitudes.Our findings contribute to this discourse by showing how structured educational programs, based on sound theoretical frameworks,  This study delves into the broader implications of these educational strategies for the nursing profession and other health professions.It suggests that such innovative approaches are beneficial not only for improving care for older adults but also essential for preparing healthcare professionals across various disciplines to meet the challenges of an increasingly complex healthcare environment.
This study provides valuable insights into the development and efficacy of innovative educational strategies in gerontological nursing.By situating our findings within the wider context of current nursing education research, the study underscores the need for holistic, technologically informed, and person-centered approaches in the care of older adults.Our research contributes to the ongoing dialogue in nursing education, highlighting the imperative for adaptive and empathetic educational models in preparing nursing professionals for the future of healthcare.

Conclusion
This study significantly contributes to the field of gerontological nursing education through the development and evaluation of the Innovative Gerontological Nursing Intervention Mapping Initiative for Training and Education (IGNITE).This program, designed with a focus on holistic and contextual learning, innovative educational strategies, and person-centered care, demonstrates a substantial potential to enhance nursing practices and outcomes in the care of older adults.
The IGNITE program effectively addressed initial negative perceptions held by clinical nurses towards older adults.Nurses, who initially viewed older adults as burdensome and uncooperative, underwent a transformative learning experience.This process of critical self-reflection and engagement with innovative educational methods led to a paradigm shift in their attitudes and behaviors.The nurses emerged with a newfound empathy, respect, and understanding for older adults, underlining the efficacy of IGNITE in fostering compassionate and empathetic gerontological care.
Furthermore, this study lays a robust theoretical and methodological foundation for the development of adult learning educational materials targeted at clinical nurses.
The insights garnered from the IGNITE program can be instrumental in shaping educational content across various healthcare settings, promoting transformative learning and self-reflection.This approach not only leads to innovative nursing practices but also contributes to personal and professional growth in diverse work environments.
Looking ahead, it is imperative to investigate the longterm impacts of the IGNITE program on nursing practices and patient outcomes.Future research should also explore the application of the Intervention Mapping Approach in other healthcare professions and assess the scalability of the IGNITE program.With the global demographic trend towards an aging population, it is crucial to equip nurses and other healthcare professionals with the necessary skills, knowledge, and attitudes to deliver high-quality, person-centered care to this growing vulnerable group.
In conclusion, the IGNITE program represents a significant advancement in gerontological nursing education.It underscores the necessity of ongoing research and development to meet the evolving needs of healthcare professionals in an aging world.This study marks an important step in this direction, highlighting the transformative potential of innovative educational approaches in the realm of nursing and healthcare.
The participants were informed that they had the right not to participate and could withdraw from the study at any time.The procedure of the data collection process was explained to all participants, and information regarding the estimated time and number of contacts with participants was provided.The participants were not subject to any physical, psychological, social, or economic harm or risk, as the data collection process primarily relied on a descriptive, noninvasive questionnaire.All participants were given rewards for their engagement.

Fig. 1
Fig. 1 Summary of the IMA phases

Table 1
General Characteristics of Participants (N = 30)

Table 2
Mapping of Course Objectives

Table 3
Learning Objectives, Modules, and Teaching Methods in the IGNITE Program • Learners will implement evidence-based nursing interventions to enhance independence, mobility, and quality of life in older arthritis patients.Learners will navigate ethical dilemmas associated with death and develop a new framework for end-of-life care.•Learners will experience a cognitive and emotional shift in end-of-life and pre-dying care, leading to the creation of personal nursing narratives.

Table 4
The effect of the IGNITE program (N = 30)

Table 5
Scores for Transformative Behavior Change and Program Satisfaction among Participants (N = 30)